Injuries to the dorsum of the hand and fingers are common presentations to hand surgeons due to the associated injuries to the extensor tendons. Repair is critical to avoid extensor lag that impairs function and to prevent progressive deformity of the digit, such as Mallet Finger or Swan-neck deformity. Injuries resulting in loss of tendon substance are especially challenging due the limited excursion of the extensor tendon. This is particularly true for the terminal extensor tendon.

Multiple techniques have previously been described for reconstruction of the terminal extensor tendon including tendon grafts [1,2], grafts of extensor retinaculum [3], tendon flaps from the lateral bands [[4], [5], [6]], as well as fusion of the distal interphalangeal (DIP) joint [7]. In this paper we describe our novel technique that is a variant on the retrograde tendon flap described by Snow [8] in reconstructing the terminal extensor tendon as well as our approach to soft tissue coverage in managing a case with a complex injury.